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AUSTIN, Texas — The partnership between one of the nation’s largest Catholic health systems and a local government agency focused on caring for poor patients was supposed to be mutually beneficial for everyone involved. But it didn’t quite turn out that way.

The alliance in theory meant that Travis County, home to the growing metro area of Austin, could provide more care to low-income patients cheaper than other big cities in the state. And Ascension, a not-for-profit behemoth, would get to own a brand-new teaching hospital and work with an elite new medical school at the University of Texas at Austin.

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But two decades after the agency and Ascension first came together in the name of providing care for poor patients, their relationship has almost completely unraveled.

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